The association between major trauma centre care and outcomes of adult patients injured by low falls in England and Wales

Abstract

ABSTRACTBackgroundDisability and death due to low falls is increasing worldwide and disproportionately affects older adults. Current trauma systems were not designed to suit the needs of these patients. This study assessed the effectiveness of major trauma centre care in adult patients injured by low falls.MethodsData were obtained from the Trauma Audit and Research Network on adult patients injured by falls from <2 metres between 2017-2019 in England and Wales. 30-day survival, length of hospital stay and discharge destination were compared between major trauma centres (MTCs) and trauma units or local emergency hospitals (TU/LEHs).Results127,334 patients were included of whom 27.6% attended an MTC. The median age was 79.4 years (IQR 64.5-87.2 years), and 74.2% of patients were aged >65 years. MTC care was not associated with improved 30-day survival (adjusted odds ratio [AOR] 0.91, 95% CI 0.87-0.96). Transferred patients had a significant impact upon the results. After excluding transferred patients, the AOR for survival in MTCs was 1.056 (95% CI 1.001-1.113).ConclusionTU/LEH care is at least as effective as MTC care due to the facility for secondary transfer from TU/LEHs to MTCs. In patients who are not transferred, MTCs are associated with greater odds of 30-day survival in the whole cohort and in the most severely injured patients. Future research must determine the optimum means of identifying patients in need of higher-level care; the components of care which improve patient outcomes; and develop patient-focused outcomes which reflect the characteristics and priorities of contemporary trauma patients.KEY MESSAGESWhat is already known on this topicCurrent trauma systems were not designed to manage rising numbers of elderly patients injured by low falls.Previous evidence for the role of major trauma centre (MTC) care in such patients yielded conflicting results.What this study addsThis study demonstrates that non-trauma centre care is no worse than MTC care, as long as the possibility of transfer exists.Therefore MTCs do have a role in the management of elderly adults injured by low falls, particularly the severely injured.How this study might affect research, policy or practiceResearch must identify those patients who need transfer, the most effective components of care, and patient-centric outcomes.